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• 35 year old female was admitted with history

of high grade fever associated with severe


headache and recurrent bouts of vomiting for
the past 5 days. On examination, Kernigs sign
and Brudzinsky signs were positive. A Lumbar
puncture was done and the CSF analysis
results are as follows :
• Appearance : cloudy
• Pressure (mm water): 210
• Protein (mg/dL) : 110
• Glucose (mg/dL) : 20
• Cells per microlitre : 800, N-80%
• A 75 year-old male presents with difficulty in
initiation of movements, difficulty in walking and
writing; on examination, he has coarse tremors in
limbs even at rest with rigidity and low
monotonous voice

• What is your likely diagnosis?


• What is the pathophysiology?
• What are the inclusion bodies seen on
histopathological examination of the cells from
the substantia nigra?
• How will the patient’s gait be?
• Two classes of drugs used in treatment?
• 40 year old male was admitted with history of
fever with severe headache and recurrent bouts
of vomiting for past 7 days. On examination,
Kernigs sign and Brudzinsky signs were positive. A
Lumbar puncture was done and the CSF analysis
results are as follows :

• Appearance : Clear
• Pressure (mm water) : 280
• Protein (g/dL) : 60
• Glucose (mg/dL) : 55
• Cells per microlitre : 50 lymphocytes
• Gram Stain : No organisms seen
• 43 year old male was admitted with history of
fever with history of severe headache and
recurrent bouts of vomiting for the past 30 days.
On examination, Kernigs sign and Brudzinsky
signs were positive. A Lumbar puncture was done
and the CSF analysis results are as follows :

• Appearance :turbid with cobweb coagulum
• Pressure (mm water) : 320
• Protein (g/dL) :65
• Glucose (mg/dL) : 35
• Cellsper microlitre :500 , L-80%
• Gram Stain : No organisms
32 year old male presented with fever for 1 month ,right sided pleuritic
chest pain and progressive breathlessness. Clinical examination revealed
right sided moderate pleural effusion. Pleural fluid analysis done was as
follows :
– Protein : 6 g/dL
– Albumin : 2 g/dL
– LDH : 150 U/L
– ADA : 72 units/dL
– Microscopy : predominantly lymphocytes
– Gram stain : no organisms seen
– Glucose : 20 mg/dl

• The serum values of the same were


– Protein : 8g/dL
– Albumin : 3g/dL
– LDH : 180 U/L
– 70 year old female who is known hypertensive on irregular
medications presented with progressive exertional breathlessness for
past 7 days. Chest X ray revealed a right sided moderate pleural
effusion.Pleural fluid analysis done was as follows :

– Protein : 3 g/dL
– Albumin : 2 g/dL
– LDH : 90 U/L
– ADA : 20 units/L
– Microscopy : No cells seen
– RBC : Nil
– Gram stain : no organisms seen
– Glucose : 65 mg/dl

• The serum values of the same were


– Protein : 7g/dL
– Albumin : 3g/dL
– LDH : 180 U/L
55 year old female presented with high grade fever associated with chills
for 1 week left sided pleuritic chest pain and progressive breathlessness.
Clinical examination revealed left sided moderate pleural effusion with
intercostal tenderness and fullness of the left lower intercostal spaces.
Pleural fluid analysis done was as follows :

– Protein : 6 g/dL
– Albumin : 2 g/dL
– LDH : 150 U/L
– ADA : 10 units/dL
– Microscopy : predominantly neutrophils
• and plenty of pus cells
– Gram stain : Gram positive cocci in clusters
– Glucose : 20 mg/dl

• The serum values of the same were


– Protein : 8g/dL
– Albumin : 3g/dL
– LDH : 180 U/L
Mr.V,a 21 year college student reports to OPD with 4 days history of
intermittent fever,nausea and loss of appetite
O/E,he is febrile,icterus+,righthypochondrial tenderness+
Lab investigations revealed the following
• Hb-13.6g/dL
• TC-7000cells/mm3
• TOTAL BILIRUBIN-5.8mg/dL
• AST-789 U/L
• ALT-1276 U/L

• 1.WHAT IS THE PROBABLE DIAGNOSIS HERE?


• 2.WHAT OTHER INVESTIGATIONS WILL YOU DO TO CONFIRM THE
DIAGNOSIS?
• 3.NAME TWO CLINICAL CONDITIONS THAT PRODUCE AN
ELEVATION OF TRANSAMINASES ABOVE 1000 U/L?
• 4.HOW WILL YOU MANAGE THIS PATIENT?
Ms. SV, a 16 year old girl presents with complaints of easy fatigability an
recurrent episodes of URTI.She also noticed unprovoked bleeding from her gums and
blood tinged nasal discharge

O/E
• Pallor+,sternal tenderness+
• P/A-hepatosplenomegaly+

Her BLOOD report is given:


• Hb-7g/dL
• TC-72000/mm3
• PLATELET-90000/mm3
• Peripheral smear showed multiple blasts with prominent nucleoli and auer rods

• 1.COMMENT ON THE LAB REPORTS


• 2.NAME TWO CYTOGENETIC ABNORMALITIES ASSOCIATED WITH THIS CONDITION
• 3.HOW WILL YOU CONFIRM THE DIAGNOSIS?
• 4.HOW WILL YOU MANAGE THIS PATIENT?
Mrs. R underwent a laparotomy for DU perforation 5 days
back.Now she complains of sudden onset breathlessness
and blood stained expectoration.
O/E-
• She is tachypnoeic
• Pulse-130/min
• BP-70/40mmHg
• Chest x ray showed a wedge shaped opacity in right
lower zone
• 1.WHAT IS YOUR DIAGNOSIS?
• 2.WHAT OTHER INVESTIGATIONS WILL YOU DO IN THIS
CASE?
• 3.WHAT IS THE TREATMENT OF THIS CONDITION?
• 4.WHAT PREVENTIVE MEASURES WILL YOU ADVICE?
Mr.S was admitted in ED with h/o snake bite in his right foot while he was working in a
farm.He was given 8 vials of ASV because of a prolonged clotting time.2 hours later he
noticed reddish patches in his flanks and both forearms

O/E
• He was conscious
• BP-100/70mmhg
• PR-100/min
• Ecchymotic patches all over his body
• Bleeding from gums+
His lab paramaters are given below
• PT – 22s
• INR – 1.9
• aPTT- 59s
• serum fibrinogen – 50mg/dL(normal 150-400 mg/dL)
• serum FDP - >90mcg/ml(normal <10mcg/ml)
• Platelet count – 50,000/mm3
• 1.INTERPRET THE LAB VALUES
• 2.WHAT IS THE MOST PROBABLE DIAGNOSIS?
• 3.WHAT ARE THE OTHER CAUSES OF THIS CONDITION?
• 4.HOW WILL YOU MANAGE THIS CONDITION
A patient, age 24 years was admitted to the hospital with history of
generalized weakness, fatigue, bleeding from gums, epistaxis and sore throat.
Physical examination showed tachycardia, ecchymotic patches in the upper
limbs, palpation of the abdomen showed no organomegaly.

Hemogram of this patient shows:


• Hb% - 3.8%
• RBC count - 2.2 million/cumm
• Total WBC count - 2100 cells/cumm
• Differential count:
• Neutrophils - 58% Lymphocytes - 36%
• Eosinophils - 5% Basophils - 1%
• Platelet count - 82,000/cumm
• Reticulocytes 0%

• What is your diagnosis?


A 18 year old female patient reported to the OP with history of generalized
weakness,lethargy and inability to do the routine work for the previous few
months. On further questioning she complains of breathlessness and
palpitation while climbing stairs of her house and light headedness, though
not to the point of fainting. Following is her blood report :
Comment On the Haemogram Report
• 1. Hb% - 4.6%
• 2. RBC count - 4.2 million/cumm
• 3. Total WBC count - 7200 cells/cumm
• 4. M.C.V - 74fl
• 5. M.C.H - 24 pg
• 6. M.C.H.C - 32%
• 7. Reticulocytes 2%

• Normal values:
• M.C.V - 90(+-)8fl
• M.C.H - 30(+-)3pg
• M.C.H.C - 34(+-)2%
• John a 10 year old boy, suddenly developed puffiness
of the eyelids and facial edema 4 days after developing
sore throat. The urine was dark in colourand scanty,
and the blood pressure was elevated. Urine analysis
showed:

• Total quantity (24 hrs ) : 500ml


• Specific gravity : 1.029
• Albumin : present (1+)
• Sugar : Absent
• Microscopy : plenty of RBCs, blood casts,
granular casts

• Comment on the report.


• 46 years old male presented with H/O facial puffiness more during early
morning followed by development of generalized edema.
O/E:
• Pulse : 74bpm
• BP : 110/70 mmHg
• Pallor+, Pedal & Periorbital edema noted, JVP: Normal, Ascites+

• Investigations:
• S.creatinine : 1.4mg/dl
• Urine examination:
• Sugar : nil
• Protein : 3+
• RBC : 1-2 cells/hpf
• Pus cells : Nil
• Cast : granular , hyaline and fatty casts +

• What’s your diagnosis?


• What are the causes of this condition?
• 35-year old female developed weakness of lower limbs
and weakness of extra-ocular muscles. Weakness
progressed more in the evening. On examination,
patient had ptosis and neck muscle weakness. Reflexes
are preserved with no bowel and bladder involvement

• What is the possible diagnosis?


• What drug is used as a diagnostic aid for this condition
• What are the antibodies associated with this condition
• True or false – 15% of cases have a thymoma
• Name two antibiotics that should be avoided in this
condition
• 40 years old male patient, presented with h/o Abdominal
distension for past 2 months. Patient is an alcoholic for past
20 years and he drinks almost everyday. O/E Patient is
having Icterus and tense ascitis. Ascitic fluid tapping was
done
• Ascitic fluid analysis-
• Total count : 120, PMN: 64%, Lymphocytes: 30%
• Ascitic Fluid Protein: 2.8 g/dL S.Protein: 5 g/dL
• Ascitic fluid Albumin: 0.9 g/dL S.Albumin:2.2 g/dL
• What is the provisional diagnosis in the patient and why ?
• What is Serum – Ascitic – Albumin Gradient and What are
the causes of high SAAG Ascitic ?
• What are the various complications do you expect in this
patient ?
• How will you treat this patient ?
• What are the other investigations you will do to assess the
prognosis of this patient ?
• 50 years old female presented with h/o fever, weight loss,
anorexia and abdominal pain since 3 weeks. O/E patient
was cachexic with doughy abdomen. USG abdomen should
measentric lymphadenopathy and ascitis. Blood
investigation and Ascitic tapping was done and it as follows
• ESR: 88 mm, LFT-N
• TC : 600, L: 55 % , N-45%
• S.Protein : 6.1 g/Dl Ascitic Protein: 4 g/dL
• S.Albumin : 3.8 g/dL Ascitic Albumin: 3.0 g/Dl
• What is your provisional diagnosis and why ?
• What are the various differential diagnosis you suspect in
this patient ?
• What is ADA and what is its significance ?
• What are the various other investigations you would like to
do in this patient ?
• How do you differentiate this patient from a case of
perforative peritonitis ?